Beiträge zur Frage der apoplectiform auftretenden Encephalitis.

Gecorrigeerd via dispenserDiss. Jena.OPLADEN-RUG0

Primary care of burn wounds

Adequate therapy of burn wounds begins at the scene of the accident or injury, by stabilizing the vital functions of the patient and roughly estimating the burn surface area and depth. This yields an indication for further out- or in-patient treatment, or for therapy at a special burn-treatment center. First-aid of burn wounds at the scene of the injury consists of cooling the burned areas. At the hospital or clinic, the burns should be immediately cleaned, disinfected, and covered with a sterile dressing. Superficial burns of degree IIa can usually be allowed to heal by re-epithelialization. Top priority is given to a painless procedure and a result with little scarring, which can be predominantly achieved by avoiding exogenous infections, for instance, by applying compresses soaked with polihexanide-based antiseptics. Deep burns of degree IIb to III should be debrided soon, and the lesions covered by skin transplants. The goal is a rapid, complete wound closure without infection, in order to reduce or entirely avoid scar formation.Die adäquate Therapie von Verbrennungswunden beginnt bereits am Unfallort mit der Stabilisierung der Vitalfunktionen des Patienten und grober Einschätzung von Verbrennungsfläche und -tiefe. Hieraus ergibt sich die Indikation zur ambulanten bzw. stationären Weiterbehandlung, ggf. zur Therapie in einem speziellen Brandverletztenzentrum. Die Erstbehandlung der Verbrennungswunden am Unfallort besteht in der Kühlung der verbrannten Areale. In der weiterbehandelnden Einrichtung sollen die Verbrennungswunden umgehend gereinigt und desinfiziert sowie steril abgedeckt werden. Oberflächliche Verbrennungen Grad IIa können in der Regel durch Reepithelisierung zur Abheilung gebracht werden. Im Vordergrund stehen ein schmerzfreies Vorgehen und ein narbenarmes Ergebnis, das vor allem durch die Vermeidung von exogenen Infektionen z.B. durch Auflegen von mit Polihexanid-basierten Antiseptika getränkten Kompressen erreicht werden kann.Tiefgehende Verbrennungen Grad IIb bis III sollten zeitnah debridiert und die entsprechenden Areale mittels Hauttransplantation gedeckt werden. Ziel ist ein rascher kompletter Wundverschluss ohne Wundinfektion, um die Narbenbildung zu verringern bzw. vollständig zu vermeiden

Necrotizing streptococcal myositis of the upper extremity: a case report

Abstract Background Necrotizing myositis is a rare but life-threatening soft-tissue infection characterized by rapidly spreading inflammation and subsequent necrosis of the affected tissue. The myositis is often caused by toxin-producing, virulent bacteria such as group A β-hemolytic streptococcus and associated with severe systemic toxicity. It is rapidly fatal unless diagnosed promptly and treated aggressively. However, necrotizing myositis is often initially misdiagnosed as a more benign soft-tissue infection as such fulminant, invasive muscle infections are rare with no more than 30 cases reported over the last century. Case presentation We illustrate the case of a 74-year-old male Caucasian initially presenting with a progressing swelling and gradually oncoming pain of the upper right extremity. Rapidly, livid discolorations of the skin, blisters, hypoesthesia and severe pain resistant to analgesics treatment developed accompanied by disruption of the arterial blood flow. Due to a manifest compartment syndrome the patient was admitted to theater for fasciotomy of the arm. After multiple revision surgeries wound closure was achieved using a pedicled, fasciocutaneous parascapular flap and a free, ipsilateral anterolateral thigh flap. Microbiological analysis revealed group A β-hemolytic streptococcus, histology a bacterial interstitial myositis with necrotic muscular fibers. Conclusions A high degree of clinical suspicion is necessary to avert potentially disastrous consequences of necrotizing myositis. Timely diagnosis, broad-spectrum antibiotic therapy, and aggressive surgical debridement of affected tissue are keys to the treatment of this serious, often life-threatening infection